IUD

What is IUD?

IUD means Intra Uterine Device. It is a little piece of plastic which has the shape of a " T " with a string attached to it (the little string hangs just outside the cervix in the vagina).
The IUD is put in the uterus during the periods of the woman. It prevents the sperm cells to reach the ovum and so avoid pregnancy. [1] and Annex 1) [2]
There are two kinds of IUD:

1. the copper IUD: can be used up to 10 years
2. the hormonal IUD (=IUS): can be used up to 5 years

The copper IUD can cause allergies since some women are allergic to copper. Of course in this case,women won't use a copper IUD.

What does the little string stand for?

The little string allows the woman to check that the IUD is still in place. The little string is also useful for the removal of the IUD.

Is it effective in preventing pregnancy?

Yes, IUD is one of the highest efficient method of birth control. Studies show that for every 100 women, less than 1 will get pregnant each year.

1. The copper IUD is 99,5% effective
2. The hormonal IUD is 99% effective
   

For instance, the pill is efficient at 97%, so we can see that IUD is more effective than the pill that most of the women use. [3]

How does IUD work?

1. Copper IUD:

Actually experts don't really know why the copper IUD is so efficient in preventing pregnancy. All we know is that IUD inhibits the sperm joining the egg by blocking the Fallopian tube's (see Annex 2) [4] entrance, and that copper has a toxic effect on the sperm and egg.

1. Hormonal IUD:

The hormonal IUD has a little steroid reservoir that contains 52 mg of LNG (=levonorgestrel). Every day it releases about 20 µg LNG to the endometrium which makes it unresponsive to oestradiol (=female hormone that modify the uterus and the vagina to prepare a possible pregnancy). The endometrium is then inactive, it isn't able to receive a fertilized egg. That's why women using hormonal IUD have less bleedings.
See Annex 3) and [5]

LNG also thickens cervical mucus, making sperm penetration more difficult.

Does IUD kill an embryon?

As said above, the hormones released by the hormonal IUD makes the endometrium inactive. Thus, if a sperm cell joins the egg and the fertilization occurs, the embryon won't be able to do the implatation because the endometrium isn't thick enough to receive it. Then, the egg will arrive on the endometrium, and die. All the process is shown in this video: [6]

What are the problems concerning ethics?

What is explained just above involves an important question about ethics. IUD is an effective method to prevent pregnancy, this is for sure, but we can discuss the fact that sometimes it kills an embryon and so it kills a living organism. Killing a sperm cell and an embryon isn't the same thing! From different point of views the question of ethics is very important and not just for IUDs but for any contraception method and abortion. We may use contraceptions to avoid having too many babies, but to kill embryons is an important question to discuss. In general, religious people are against those methods, and a there's a permanent conflict about this topic that stands between religion and science.

For more informations :
Abortion#What_are_the_ethical_issues_of_abortion.3F
Contraception_Ethics

Does IUD protect you from STDs (=Sexually Transmitted Diseases)?

A woman using IUD is NOT protected from STDs. IUD is a permanent contraceptive method, women might forget that they are NOT protected against STDs. That's why she has to be sure that her partner hasn't got any infections and that he's faithful. Of course, the woman also has to have only one partner.
For more informations: STDs

What must a woman do before inserting IUD?

As IUD does not protect from infections, the woman has first a general medical exam; breasts exam, pelvic exam, pregnancy test. If everything is all right, the doctor inserts the IUD.
Before IUD insertion, her cervix has to be dilated hormonally which is very uncomfortable and sometimes painful. That's why painkillers are given before the insertion.

How much time does a woman have to wait to have sexual intercourse?

The IUD is usually inserted during the mestrual period. After having put it, the woman feels cramping for a few moments, but if she'd like to she can have sexual relations.
It's up to you: once IUD is inserted, you don't have to wait, it's immediatly effective.

Does a woman or her partner feel it?

The partner does not feel the IUD, and the woman neither. But the woman has to check if the IUD is still in place, she has to see if the string is still the same length. She may use a mirror or go to the clinic. If the string is still in place that means that the IUD didn't move, if not that means that the IUD moved or that it has been expelled. In that case there is a risk for the woman to be pregnant because it has lost its efficiency, the best thing to do is to use a pregnancy test immediatly and call the clinic where the woman put it.

Can we remove it once we decided to use it?

A woman can remove it at any time. The removal is quicker and easier than the IUD's insertion. An IUD is efficient from 1 to 10 years. During this time, the woman for any reason can ask for the removal.
If the removal is near ovulation, the woman may become pregnant from an intercourse before IUD's removal!

Are there any risks for a woman using IUD?

Yes there are some risks! It is rare but the uterus can be hurt during the IUD's insertion.
During the firt year of use, the IUD may be expelled through the cervix, it happens especially to women who never had children and to the women that inserted the IUD just after childbirth.
A woman who has already inserted an IUD, but who would like a baby in few years may have troubles in becoming pregnant. Most of the women become pregnant after IUD removal, but a few ones can't become pregnant anymore. This is a risk which has to be taken in account. There's also a risk of pelvic infections.

What are IUD's advantages?

• The woman doesn't have to remember if she has to take the pill or not, and the man doesn't have to use condoms
• It lasts during 10 years maximum, it means that during those years you don't have to buy any contraception pills and so on. Thus, the woman spares money!
• Once you've inserted it, it works immediatly
• If a woman wants to remove it, the doctor can do it at any time
• It's an efficient method in preventing pregnancy (~99.5% effective)
• Less bleedings than before (for the HORMONAL IUD)
• Neither the woman nor the partner feel it
• No impact on breastfeeding
• Low risk of side effects

What are IUD's disadvantages?

• Short-term use is costly because to insert it is expensive.
• Painful menstrual periods, more bleedings than before (for the COPPER IUD)
• You may injure the woman's uterus
• It doesn't protect against STDs
• There are risks to not become pregant anymore once IUD's removed

References

1. http://www.snv.jussieu.fr/vie/dossiers/levoru486/images/modes_contraception.swf
2. http://www.fpa.org.uk/information/leaflets/documents_and_pdfs/detail.cfm?contentid=151
3. http://www.jr2.ox.ac.uk/bandolier/band35/b35-2.html
4. http://www.drspock.com/article/0,1510,5541,00.html

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